July 01, 2016

ACRs Pisano Sees Opportunities in Cancer Moonshot

Radiologist Etta Pisano, MD, FACR, the American College of Radiology’s senior director of research development, and vice chair of radiology at Beth Israel Deaconess at Harvard Medical School, expressed optimism and some reservations about the Obama Administration’s highly touted Cancer Moonshot after participating in the program’s June 29 summit in Washington.

After introductory comments by Vice President Joe Biden, Pisano visited several breakout rooms at Howard University in Washington, DC, to help develop action plans based on the Moonshot’s objectives with other distinguished cancer researchers, patient advocates, medical device and pharmaceutical industry representatives and information technology experts.

Overall, the initiative aims at doubling the rate of progress of cancer prevention, diagnosis and treatment in the next five years. President Obama announced the initiative and assigned its leadership to Biden at his final State of the Union address in January. The White House later announced $195 million in new revenue for NIH in Fiscal Year 2016 as part of a nearly $1 billion proposed for the Cancer Moonshot.

As a designated representative of radiology and medical imaging research, Pisano’s credentials include her current work for the College and experience as vice chair of research at Beth Israel-Deaconess Medical Center, dean emerita of the Medical University of South Carolina and principal investigator of the Digital Mammographic Imaging Screening Trial (DMIST) and the upcoming Tomosynthesis Mammographic Imaging Screening Trial (TMIST).  In an interview, Pisano said she is impressed by the Moonshot’s audacious goals and potential for improved cancer detection, diagnosis and treatment, though more planning is needed to assure successful implementation.

“The progress toward better cancer diagnosis and treatment has always been too slow,” she said. “Lots of laudable and exciting initiatives were announced at the summit, though the meeting was long on aspirations and short on how things are going to happen.”

There was nearly a complete consensus at the summit in favor of a central repository for cancer research and patient data, for example. The repository would include clinical, imaging and biologic data from individual cases, clinical trials and research. They would be accessible to patients and accessible for various purposes, such as scientific research, quality assurance improvement and patient-centered aims, she said.

As a radiologist, Pisano mentioned the role and importance imaging-based cancer screening in the context of a continuum of care. She also discussed the importance of storing clinical and research images as well as biological data in the proposed repository. Technical problems with a central repository seemed soluble, and those present acknowledged obstacles exist because of the culture of academia and industry, but it became clear from Pisano’s discussions with other participants that administrative, legal, and regulatory obstacles could stand in the way.

“Everyone in my breakout sessions wanted to achieve this objective, and the patient advocates argued passionately for it, but the discussion ultimately turned to what their lawyers would say,” she said.

Congressional and some state legislative actions are probably needed to break through likely legal logjams, she said. Though some participants questioned whether the federal government is capable of reducing bureaucratic red tape and whether the repository should be housed under its control. Pisano believes its leadership is necessary to building necessary infrastructure, eliminating unnecessary regulation and passing enabling legislation.

The next step for Pisano is a letter to Biden to summarize her thoughts.

“I’m sure many people in radiology would like to see this happen,” she said. “We are ready to roll up our sleeves to do it.”

Advocacy in Action readers can contribute their research ideas for the Cancer Moonshot at the National Cancer Institute's Research Ideas webpage.

A specific subsection of the page and LINK to the site is dedicated to prevention and early detection. The submission deadline is July 1 at 11:59 p.m. EDT.